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Abstract: PO2154

Guiding Kidney Transplant Candidates for Effective Weight Loss

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kukla, Aleksandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Diwan, Tayyab S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Collazo-Clavell, Maria L., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Lorenz, Elizabeth C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Clark, Matthew M., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Denic, Aleksandar, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Park, Walter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Schinstock, Carrie A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Amer, Hatem, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Smith, Byron H., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Issa, Naim S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Bentall, Andrew J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Dean, Patrick G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Kudva, Yogish C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Mundi, Manpreet, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Stegall, Mark D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Acceptance criteria at most transplant centers for waitlisting include BMI. The best approach to weight loss to facilitate active listing is unknown.

Methods

We aimed to determine the weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4 (4.6) and diabetes treated conservatively for obesity for 1-year post weight loss consultations, where the surgical and non-surgical weight loss options were discussed. A comparator group (n= 15) included patients with the mean BMI of 43.1 (4.4) who had bariatric surgery by 1 year post consultation.

Results

The mean BMI at 1-year follow-up in the studied group (n=28) was 43.0 (4.8), and total body weight loss was 4.4 (8.2) kg (3.6% (6.5). BMI has not improved at 2 years (p=0.8; Figure 2A). Eighteen patients (64%) remained ineligible for a transplant due to excess weight and/or comorbidities over a mean follow-up of 4.0 (2.9) years. Most patients (75%) did not achieve an acceptable BMI for transplant. In contrast, total body weight decreased by 22.18 (10.1) kg (19% (7%)) at 6 months post-bariatric surgery with the BMI of 34.2 (4) and 32.5 (3.7) at 6 and 12 months, respectively (Figure 2B). Bariatric surgery was associated with subsequent kidney transplantation (HR = 5.75; CI [1.49, 22.14]; p = 0.01).

Conclusion

A conservative weight loss approach was ineffective in most kidney transplant candidates with diabetes to improve access to transplantation. These data suggest the need for larger controlled trials.

Baseline characteristics
FactorNo bariatric surgeryBariatric surgeryp valueAll
Age at evaluation52.3 (11.9)53.0 (9.2)0.8352.5 (11)
Male gender15 (53.6%)5 (33.3%)0.2020 (46.5%)
BMI at weight loss consultation44.4 (4.6)43.1 (4.4)0.3743.9 (4.5)
Dialysis14 (51.9%)9 (60.0%)0.6123 (54.8%)
Diabetes type 2 (vs. type 1)23 (82.1%)14 (93.3%)0.3137 (86%)
Follow up (years)4.5 (3.1)3.6 (2.2)0.294.1 (2.8)

Data presented as Mean (SD), or N (%). BMI=body mass index.